Childhood Socioeconomic Status and Late-Life Mortality: Sex and Race Differences

描述（由申请人提供）：原生家庭的社会经济地位（SES）是可能涉及慢性疾病病因和生存的多种多样环境暴露的基本指标。研究表明，童年时期社会经济地位较低的男性和女性，无论其成年后的社会经济特征如何，其死亡风险都会增加。儿童期较低的社会经济地位和较高的心血管死亡风险之间已经建立了最一致的联系。此外，来自社会经济地位较低家庭的男性和女性死于呼吸道和消化系统疾病、糖尿病、与吸烟有关的癌症、胃癌和肝癌的死亡率较高。然而，现有的研究存在一些局限性。在大多数研究中，早期的社会经济地位是用一个指标来评估的，通常是父亲的教育或职业，通常是回顾性的。此外，很少有研究明确考察了性别和种族差异对早期社会经济地位对死亡率的影响，以及解释这种影响的生命历程途径。最后，连接儿童SES和成人死亡率的中介机制仍不清楚。一项重要的任务是通过采用与生命过程路径的理论重点相一致的方法来扩大生命过程流行病学的方法库。利用威斯康星纵向研究和健康与退休研究的数据，我将应用Cox回归和结构方程模型来检验早期社会经济地位对晚年全因、心血管和癌症道德的影响，以及这种影响的性别和种族差异。此外，我建议探索社会经济特征、婚姻状况和成年后的健康行为作为早期生活SES和晚年死亡率之间关联的中介。最后，我将分析将早期社会经济地位和晚年死亡率联系起来的因果途径是否以及如何因性别和种族而异。本研究将为社会优势和劣势的生命轨迹以及这些轨迹的性别和种族/民族异质性提供新的证据。此外，探索生命早期社会经济环境与晚年全因和特定原因死亡率之间的联系机制，将提高我们对生命阶段的理解，这可能是预防工作中最重要的。

DESCRIPTION (provided by applicant): Socioeconomic status (SES) of the family of origin is a fundamental indicator of multiple and diverse environmental exposures that might be implicated in chronic disease etiology and survival. Research indicates that men and women with lower SES during childhood have an increased risk of mortality, independent of their socioeconomic characteristics in adulthood. The most consistent link has been established between lower childhood SES and an elevated risk of cardiovascular mortality. In addition, men and women from lower-SES families of origin have elevated mortality from respiratory and digestive diseases, diabetes, smoking-related cancers, and stomach and liver cancers. Yet existing research is characterized by several limitations. In most studies, early-life SES was assessed with one measure, typically fathers' education or occupation, often retrospectively. Moreover, few studies have explicitly examined gender and race differences in the effect of early-life SES on mortality and in the life course pathways explaining this effect. Finally, the mediating mechanisms linking childhood SES and adult mortality remain unclear. An important task is to broaden the methodological arsenal of life course epidemiology by employing methods that are consistent with the theoretical emphasis on life course pathways. Using data from the Wisconsin Longitudinal Study and the Health and Retirement Study, I will apply Cox regression and structural equation modeling to examine the effect of early-life SES on all-cause, cardiovascular, and cancer morality in later life as well as gender and race differences in this effect. Further, I propose to explore socioeconomic characteristics, marital status, and health behaviors in adulthood as mediators of the associations between early-life SES and late-life mortality. Finally, I will analyze whether and how causal pathways linking early-life SES and later-life mortality differ by gender and race. The proposed study will provide new evidence of life course trajectories of social advantage and disadvantage and heterogeneity of these trajectories by gender and race/ethnicity. Moreover, the exploration of mechanisms linking early-life socioeconomic environment to all-cause and cause-specific mortality in later life will improve our understanding of life stages that may be potentially the most important for prevention efforts. PUBLIC HEALTH RELEVANCE: The proposed study has potentially important public health implications. The exploration of causal mechanisms linking early-life socioeconomic environment to all-cause and cause-specific mortality in later life will improve our understanding of life stages that may be potentially the most important for prevention efforts. Because early-life socioeconomic conditions exert their influence on mortality over a long time span, they are more amenable than contemporaneous conditions in adulthood to preventive interventions between childhood and the manifestation of the disease.